Visibility of the nailfold blood vessels plexus has been known for a long time as a biological marker in schizophrenia.

Schizophrenia became known for a high occurence of minor physical anomalies (MPA’s). Interestingly, one of the typical MPA’s in schizoprenia concerns visibility of the blood vessels in the proximal nailfold – a.k.a. ‘nailfold plexus visibility’ (NPV – which requires the use of a microscope for proper assessment). It concerns a minor developmental abnormality that has been studied as a hand marker for schizophrenia, but which lies outside the scope of the traditional MPA construct. Because nail fold plexus is commonly seen in the hands of young children, but not in adults. The statistics show that a high level of nailfold plexus visibility is relatively rare in the general population (occurring in 3-7% of healthy adults) while the rate of high NPV ranges from 20-70% in populations with schizophrenia (Curtis et al., 1999).

Interestingly, over the years studies have suggested this hand characteristic is specificly related to the so-called ‘negative symptoms’ in schizophrenia (which are associated with deficits of normal emotional responses or of other thought processes). And EEG studies have revealed that this nail fold blood vessel condition may mark a process associated with abnormal brain development leading to schizophrenia – including: an inverse relationship between plexus visibility and lateral ventricle size in the brain. The PVS is reliably determined and stable over time. Interrater reliabilities for PVS reportedly range from .83 to .99 (Buchanan and Jones 1969; Maricq 1966).

Taken together, researchers have concluded that findings on MPAs indicate that these minor anomalies appear to be part of some schizophrenia syndromes, representing a stable systemic or physical set of manifestations of the underlying neurodevelopmental processes that lead to the illness. This might explain why in the DSM-V the term ‘schizophrenia’ may be get replaced by the name ‘psychosis risk syndrome‘.

BLOOD SUPPLY IN THE SKIN:

The skin has a profuse blood supply, which is important in temperature regulation. The subcutaneous arteries form a network in the subcutaneous tissue, and from this is derived a subpapillary plexus in the dermis. Capillary loops in the dermal papillae arise from the subpapillary plexus, and from these loops the avascular epidermis is bathed in tissue fluid. A subpapillary plexus of venules gives the skin its pink color: the vessels become dilated when the skin is heated, and thereby make it look red.


NAILFOLD PLEXUS VISIBILITY & PSYCHOPATHOLOGY:

Just like is seen in the perspective of minor physical anomalies, nailfold plexia visibility is much more common in schizophrenia than in any other form of psychopathology. Studies have revealed that nailfold plexia visibility in schizophrenia is (much) more common than in other psychotic- & mood disorders – but these other disorders also show higher occurence than seen in the general population.

Studies have also shown that that patients with schizophrenia with a highly visible plexus have greater oculomotor dysfunction, negative symptoms, symptom severity, chronic course, and neuropsychological dysfunction. Furthermore, nailfold plexus visibility appears to be at least moderately heritable.


NAILFOLD PLEXUS & OTHER DISORDERS:

Other studies have revealed that nail fold plexus visibility has also been linked with hand markers in rheumatoid arthritis & hand markers in psoriasis. The pronounced subpapillary plexus visibility, greater number of vessels and their elongation are indicative of rheumatoid arthritis, while shorter, fewer capillaries and especially characteristic psoriatic capillaries, when present, suggest psoriatic arthritis.

Changes of nailfold capillary patterns have been described in certain patients with systemic sclerosis, dermatomyositis, mixed connective tissue disease, and Raynaud’s syndrome.

NOTICE: The nail tutor demonstrates how other nail fold characteristics can be associated with specific medical problems. More details about how to recognize various stages/variants of proximal nailfold blood vessels visibility in a palm reading, are presented in the picture below.


A phantom picture for the hand in schizophrenia is available here:

http://www.multiperspectivepalmreading.com/hands-schizophrenia-palm-reading.htm

Nailfold plexus examples.

Nailfold plexus changes are characterized by loss of (drop-out) nailfold capillary loops that surround the remaining, enlarged dilated capillaries. Upper left, A normal nailfold capillary pattern shows the uniform morphology and homogeneous disitribution of the small capillary loops just below the cuticle. Upper right, Capillaroscopy in a patient with systemic sclerosis illustrates dilatation of isolated capillary loops, with loss of surrounding loop structures. Lower right, The abnormal pattern is from a patient with childhood dermatomyositis. Dilated capillary loops are present, as well as areas of arborized clusters of capillary loops. Lower left, Distortion of the normal capillary loop architecture is seen in a patient with adult dermatomyositis. Note the loss of normal homogeneous distribution of the capillaries and the alterations in the morphology of the vessels, including the dilated and enlarged “giant” capillary loops.

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White spots are probably the most common ‘abnormality’ that can be observed in fingernails. Many people associate them with calcium deficiency, but the truth is that usually they do not relate to any health problem at all!

In medical science white spots in fingernails are also known as ‘leukonychia punctata’ – which related to the presence of nucleated keratinocytes (contrary: narrow white lines in the nails are known as ‘transverse leukonychia’). Usually white spots are caused by random minor trauma – which also explains why they are relatively common in the hands of children!

Zinc deficiency? – Yep!

Sometimes white spots can indicate a zinc deficiency!

White spots can sometimes be associated with a zinc deficiency – this was e.g. pointed out in a 1974 study, titled: ‘Fingernail white spots: possible zinc deficiency‘.

But in general, one should not expect to find a zinc deficiency when a person has only a few white spots. Because actually, a number of conditions can arise from a lack of zinc. One of the most important, which also lead to its discovery, was the stunting of growth and the lack of sexual development in adolescent boys; adding zinc to the diet brought about a rapid improvement. Skin complaints such as dermatitis and a condition called acrodermatitis in babies may result from deficiency, and there may be slow healing of burns and wounds. So zinc deficiency may show up as white spots or bands on fingernails, but probably only when other conditions manifest as well!

Calcium deficiency? – Nope!

White spots do NOT indicate a calcium deficiency!

The Asia Pacific Journal of Clinical Nutrition reports: “There is no evidence to support a relationship between the white flecks and calcium or any other nutritional deficiency. Of course it is possible that people who have white flecks in their fingernails may coincidentally be deficient in calcium. White spots in fingernails may result from minor damage caused by bumping the nails into hard surfaces like bench tops or machinery. These white flecks are different from the white bands that are observed in nails of some undernourished children in developing countries, and in people who have low blood protein levels for various reasons.”

 

NOTICE: Thin, brittle nails can be caused by calcium deficiency!

 

 

 

Iron deficiency? – Nope!

White spots do NOT indicate an iron deficiency!

NOTICE: Spoon-shaped nails (see photo below) may be a clue to a thyroid deficiency or iron deficiency anemia!

So, despite the many assocations – most of the stories about ‘white spots’ in fingernails are myths that are proably based on false anecdotal evidence!

SUGGESTION FOR FURTHER READING:
The clubbing nail: developments, treatment & prevention!
Hands on lung cancer: the clubbing fingernail!
Fingernail disorders & medical hand analysis!
What are the most common nail disorders?
Megan Fox has a ‘clubbed thumb’ – not to be confused with ‘fingernail clubbing’!


10 Skin & fingernail tips for men!

Men’s nails generally grow faster than women’s nails and tend to be stronger. However, their increased surface area makes them prone to trauma from bumps and bangs. Because lot’s of men never really learned how to use their hands and fingernails Dr. Daryl K. Hoffman (US plastic surgeon) compiled a TOP 10 of skin & fingernail tips – for men only!

THE TOP 10 SKIN & FINGERNAIL TIPS FOR MEN!

– 1 –
Do not bite your fingernails. Fingernail biting can break the skin, spread germs to your mouth and hands, and lead to infections. Trim nails with a nail clipper, instead!”

– 2 –
“Apply sunscreen everyday, especially if you work outdoors. Sunscreen will protect you from UV rays, that will age and weather your skin, and can lessen the harsh effect of the wind on your face!”

– 3 –
“Use moisturizer after shaving. This will soothe and smooth out your skin!”

– 4 –
“If you are losing your hair, opt for a shorter haircut. Going short can disguise balding, and makes you look much younger than the old-fashioned comb-over!”

– 5 –
“Make sure your face is clean. Men’s skin is about 15% oilier than women’s, and has larger pores. This means it is even more important to wash your face everyday. Stay away from harsh scrubs and scented soaps as they might irritate your skin!”

– 6 –
“Use a skin toner, like aftershave lotion, to reduce the size of your pores. This will help keep your skin looking younger and healthier!”

– 7 –
“Antioxidants are great for your skin. You do not need to get them from supplements; eating fruits and vegetables, like oranges and spinach, everyday will help reduce signs of aging!”

– 8 –
“Exfoliating once a week will minimize ingrown hairs, rid you of dead skin cells, and help give your face a cleaner, fresher look!”

– 9 –
“Do not forget about your lips. Use a lip balm with at least SPF 15 to protect them from sun-damaging, drying out, and cracking!”

– 10 –
“Drink eight glasses of water everyday. It is the best way to keep the skin all over your body hydrated!”

Dr. Daryl K. Hoffman - San Jose plastic surgeon

Dr. Hoffman is a Stanford University trained certified plastic surgeon – accridited by the American Board of Plastic Surgery. Dr. Hoffman utilizes the latest advances in cosmetic procedures to help people achieve their body care goals. Dr. Hoffman is committed to providing his clients with personalized care in a warm atmosphere with the highest regard for quality and medical safety.

SUGGESTION FOR FURTHER READING:

Hands, skin & fingernails: an encyclopedia!
The basics of medical hand analysis!
Your health is in your hands!
10 Tips for women: how to grow beautiful fingernails!


FINGERNAIL
DISORDERS:

Beau line - a disorder in the fingernail

Beau's lines - fingernail disorders

Beau lines

 

What are Beau lines?

Beau’s lines are horizontal grooves in the nail plate that represent an arrest or slow-down in the growth of the fingernail (more specific: the nail matrix).

The depth and width of the Beau line reveals the abruptness and duration of the causal event, and Beau lines move distally with the growth of the nail plate.

This finger nail condition was named by a French physician, Joseph Honoré Simon Beau (1806–1865), who first described the condition in 1846.

What causes Beau lines?

Beau’s lines are usually caused by:

• a sever medical event;
• allergic reaction to medication;
• infection in the nail fold;
• skin disease;
• systemic disease;
• or a serious trauma.

MORE ABOUT THIS FINGERNAIL DISORDER:
Beau line – a fingernail disorder

PHOTO: Beau lines in various fingernails:

Beau lines in various fingernails

SUGGESTIONS FOR FURTHER READING:
Fingernail disorders in the hands of children!
Fingernail disorders in elderly patients!
Michael Jackson had abnormal fingernails!

Structure of your fingernail: the nail matrix attaches the finger with the nail plate.

The matrix is an ‘invisible’ part of the fingernail – but nevertheless it’s the most important aspect of the nail because nails grow form the matrix!

The process of a growing nail can be described as follows:

Fingernails are composed largely of keratin – a hardened protein which is also present in your skin and hair! As new cells grow in the nail matrix, the older cells are ‘pushed out’, compacted, and take on the familiar flattened, hardened form of the fingernail.

In An Atlas of DISEASES OF THE NAIL the ‘matrix’ is described as follows:


“The matrix of the nail the germinative epithelium from which the nail is derived. There is controversy about whether the nail bed and nail fold contribute cells to the substance of the nail plate. Regardless of this, the matrix is responsible for the majority of the nail plate substance.

The proximal portion of the matrix lies beneath the nail folds and the distal curved edge can usually be seen through the nail plate as the white lunula. The proximal matrix forms the superfiscial portion of the nail plate and the distal matrix makes the undersurface of the nail plate.”

NOTICE: The so-called ‘root’ of the nail is also known as the germinal matrix.


Example of a nail matrix injury (A) + the repairment (B).

Example of a nail matrix injury (A) + the repairment (B).

At atlas of diseases of the nail!

At atlas of diseases of the nail!

Fingernail disorders in the hands of elderly!

Fingernail disorders in the hands of the elderly are actually quite normal. One could say that Elderly people carry the last 6 months of their medical record on the approximately 10 square centimeters of keratin comprising the fingernails!

Abnormalities of the nail are often caused by skin disease and fungal infection. But fingernail disorders may also indicate more general medical conditions.

When examing the nails it is useful to follow a sequence including these steps:

• Check the nail shape;
• Examine the nail color;
• Survey processes around the nails;
• Compare hands;
• and note skin conditions.

A few of the most common fingernails disorders in the elderly related to the fingernail shape & nail surface are: clubbed fingernails, koilonychia, Beau lines, brittle nails, onychorrhexis, nail pitting, median nail dystrophy, nail beading, rough nail surface, nail thickening, onycholysis, and severe nail curvature.

A few of the most common fingernails disorders in the elderly related to the finger nail color are: absent lunula, pyramidal lunula, lunula with red discoloration, transverse white lines, leukonychia striae, longitudinal brown lines, splinter hemorrhages, Terry’s half and half nails, white nails, pink or red nails, brown/gray nails, yellow nails, and green or black nails.

More details about these nail disorders (and many others) will be revealed in later contributions.

Examples of nail disorders: nail psoriasis, nail pitting & onycholysis.

Learn how to take care of your cuticles.

The function of the cuticle (or eponychium) in the nail anatomy is to function between the skin of the finger and the nail plate: the cuticle fuses these structures together and provides a waterproof barrier.

Many people experience problems with their cuticles for ragged cuticles can be annoying. Whatever you do, don’t snip or bite them off – instead you better use a nail pusher or a cuticle eliminator (see the picture below).

You can judge the ‘health’ of your cuticle by means of it’s: color & shape.

Actually, in terms of protection of your fingernail’s health the cuticle is likely the most important part of your nail!

A technical description of the ‘cuticle’ from An Atlas of DISEASES OF THE NAIL:


“The cuticle is the distal horny end-product of the proximal nail fold. The cuticle adhers to the nail plate and seals the nail from environmental pathogens and irritants.”

Do you have problems with your cuticles?

You can try the nail tutor:
The cuticle: find the cause of your nail disorder!

Example of how to use a cuticle eliminator.